My partner and I are trying to determine what course of action we should follow in the event of a condom breaking.

My Partner is HIV positive, I am negative. I was wondering what the level of risk would be for the transmision of the virus if we had a condom break during anal intercouse (where I was penetrating him)? would the risk level be different if I detected the breakage immediately and pulled out?

The things I have read about PEP have grouped condom breakage on the same level of risk as unprotected sex. Though you can't place a price on your personal health, I'm trying to assess if the risk level warrants the 1000+ dollars for medication & the physical side-effects of the treatment.

Response from Dr. Remien

The reference that you make to the risk of transmission with "condom breakage" being the same as unprotected sex is simply saying that once the condom breaks there is no longer barrier protection. As you probably know the risk of transmission of HIV is higher when being penetrated anally by a positive person than when you are the insertive partner. And of course, the risk is higher when there is ejaculation. Deciding to take PEP needs to be evaluated on a case-by-case basis.

For mixed status couples I would recommend that you have this discussion with your or your partner's physician. Ask the doctor when he/she would recommend that you consider taking PEP. And also discuss what you would do in the event of a significant exposure. Remember for PEP to be effective you would need to take the medication very shortly after a high risk exposure. Thus you should have a plan to be able to discuss the exposure event with a doctor and being able to access the medicine a quickly as possible, if you were to take it. You are correct in not taking this lightly and to think that it would be no big deal to take these medications. Besides the expense, they can cause a lot of unpleasant side effects and one runs the risk of developing resistance to the virus if they are not taken according to prescription.

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